finding slides for today’s webinar · 2020-04-20 · 10/16/2019 5 provider knowledge of obesity...

10/16/2019

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COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS

October 16, 2019

A Proposed Standard of Care for Adult Obesity Treatment for All Providers

Moderator: Lisa Diewald, MS, RD, LDNProgram Manager MacDonald Center for Obesity Prevention and EducationM. Louise Fitzpatrick College of Nursing

Nursing Education Continuing Education Programming Research

FINDING SLIDES FOR TODAY’S WEBINAR

www.villanova.edu/COPEClick on Dietz/Gallagherwebinar description page


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If you are calling in today rather than using your computer to log on, and need CE credit, please email [email protected] and provide your name so we can send your certificate.


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OBJECTIVES


Discuss the need for developing a standard of care of obesity treatment

Review the proposed standards of care for obesity treatment and the research leading up to their development

Identify how the proposed standards of care align with other obesity care guidelines, including obesity care competencies, development of an ideal benefit, and coverage for obesity treatment.

CE DETAILS

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation

Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration


CE CREDITS

• This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians

• Suggested CDR Learning Need Codes: 5370, 5410, 6000, 9020

• Level 2

• CDR Performance Indicators: 4.2.8, 6.1.6, 6.3.11, 8.2.5


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A Proposed Standard of Care for Adult Obesity Treatment

for All Providers

William H. Dietz, MD, PhD

Chair, Sumner M. Redstone Center

Milken Institute of Public Health

Christine Gallagher, MPAff

Research Project Director

STOP Obesity Alliance

DISCLOSURE

The planners of this program have no conflicts of interest to disclose.

Dr. Dietz has disclosed a relationship with a commercial interest related to the content of this educational activity. The educational activity was reviewed and approved by the Nurse Planner for balance in the presentation and evidence-based content and absence of bias was confirmed.

Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity.

William H. Dietz MD, PhDChair

Sumner M. Redstone Center

Proposed Standard of Carefor Adult Obesity Treatment

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Webinar Outline

• Introduction to the STOP Obesity Alliance

• Background for the proposed standard of care

• Principles for all providers

• Principles for clinical providers

• The need for an essential obesity care benefit

• Coverage

Purpose and Goals• Purpose: Convene a diverse group dedicated to reversing the

obesity epidemic in the United States

• Goals:

Lead Innovation

Strengthen systems of care

Convene diverse stakeholders

Define an innovative research agenda

Promote strategies to increase physical activity

Reduce stigma to improve health outcomes

Stakeholders Working Together to Advance Weight-Related Issues

• 15 Steering Committee Members

America’s Health Insurance PlansAmerican Diabetes AssociationAmerican Heart AssociationAmerican Medical Group AssociationAmerican Society for Metabolic & Bariatric SurgeryDonna Ryan, M.D.

• 60 Associate Member organizations (chronic disease, consumer, minority health, & provider groups)

• 4 Corporate Members

Gary Foster, PhD National Business Group on HealthObesity Action CoalitionPopulation Health AllianceThe Obesity SocietyTrust for America’s Health

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Provider Knowledge of Obesity Care is Limited

Among family practitioners, internists, OB-GYNs, and nurse practitioners (N = 1506):

Turner et al. Obesity 2018; 26:665

49% Knew that ≥ 150 mins/week of physical activity was necessary to achieve sustainable health benefits

33% Knew that any suitable eating pattern can be recommended for weight loss (NHLBI guideline)

16% Knew that 12-26 sessions during the first year is the recommended for patients with obesity

Identified Gaps in Patient-Provider Interactions

Time is the most important barrier, but providers need tools and programs

Only 39% of adults with a BMI ≥ 30.0 recalled being told that they have obesity by a HCP

One-third of patients advised to lose weight were not given a plan to do so

Most PCPs say no one in their practice has been trained to deal with weight issues

Follow-up appointments are not scheduled

TARGETS FOR IMPROVEMENT

A Proposed Standard of Care

Goal: provide a model of care for all those who care for people with obesity

• Core principles of care

• Standards of Care for all providers

• Standards of Care for clinical providers (prescribers)

• Coverage and payment policy standards

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Process for Developing a Standard of Care for Adult Obesity

2017 Steering

committee established and

met in December

2018 Three roundtable

meetings. Attendees included over 50

stakeholders, including health professionals who

care for patients with obesity, community and

non-clinic basedproviders, payers, and

patient advocates.

2019 Proposed standard of care published

Dietz, WH. and Gallagher C,“A

Proposed Standard of Obesity Care for All Providers and Payers” Obesity;

2019;27: 1059-1062.

Core Principles of Care

• Treat obesity as a chronic disease• Care should be evidence-based pragmatic and deliverable• Provide access to appropriate level of care, regardless of

point of entry• Providers should be sensitive to bias and provide appropriate

accommodation• Providers should be trained to initiate conversations about

weight• Shared decision making and bidirectional communication• Evidence-based competencies that are discipline-specific

should be met by each type of provider

Effects of Bias and Stigma

• Experience of bias and stigma increases with the severity of obesity

• Provider attitudes - people with obesity are lazy, lack self-control, and are blamed for their obesity

• Perceived provider bias affects quality of care and mistrust makes patients less likely to seek care

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Effects of Bias and Stigma (cont.)

• Bias is internalized as self-blame

• Increased risk of depression, low self-esteem, and poor body image

• Increased exposure with more severe obesity

• Increased vulnerability to unhealthy behaviors that can contribute to weight gain

Accommodations

• Provide wide-based, higher weight capacity chairs, preferably armless, in patient areas

• Offer large size or thigh-sized cuffs BP cuffs

• Provide a higher capacity scale, ideally > 500 lbs

• Locate scale in a private or near-private area to minimize anxiety and discomfort associated with being weighed

• Wheelchair accessible bathrooms

• Install floor-mounted rather than wall-mounted toilets

• Have extra-large gowns available

• Educate staff about stigma and weight bias

People First Language

• Overweight is a description

• An “obese person” is an identity – he or she is obese, not a father, mother, or a person characterized by their achievements

• An “obese person” is more likely to be held responsible tor their weight

• Obesity is a disease

• Describing a person with obesity focuses attention on cause

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The Importance of Language

Language to Use Language to Avoid

Overweight Fat

Increased BMI Obese

Severe obesity Morbid obesity

Unhealthy weight

Healthier weight

Improved nutrition Diet (or dieting)

Physical activity Exercise

Efforts to Address Knowledge and Practice Gaps

Why Weight? Provider Guide

Initiate open, productive conversations about weight and health

Assess patient readiness to change

Engage in active listening

Build trust

Establish realistic goals

Address culture and social barriers and supportswww.whyweightguide.org

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Useful Questions

Conversation starters: “Would it be all right if we discussed your weight?” “Are you concerned about the effect of weight on your health?”

Readiness: “How likely are you to consider several small lifestyle changes, such as increasing your physical activity or eating healthier”

Engagement: “What things would change if you accomplished your weight loss goals?” “What changes to your eating or physical activity habits could you reasonably make?” “How much support would you like from me if you make these changes”







Competencies Development Working Group

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National Academies of Sciences, Engineering,

and Medicine

Accreditation Council for Graduate Medical Education American Academy of Family

Physicians American Academy of Pediatrics

American Association of Colleges of

Nursing American Association of Colleges of

Osteopathic Medicine American Association of Colleges of

Pharmacy American Board of Obesity Medicine American Council of Academic Physical

Therapy American Dental Education Association Association for Prevention Teaching and Research

Association of American Medical Colleges Association of Schools and Programs of

Public Health Centers for Medicare and Medicaid

Services

Interprofessional Education Collaborative

National Organization of Nurse Practitioner Faculties

Physician Assistant Education Association Society for Public Health Education

Society of Teachers of Family Medicine The Obesity Society YMCA of the USA

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Obesity Care Competencieswww.obesitycompetencies.gwu.edu

Core Obesity Knowledge• Obesity as a medical condition• Epidemiology & key drivers of the obesity epidemic• Disparities / inequities in obesity prevention & care

Interprofessional Care• Interprofessional obesity care• Integration of clinical & community care systems

Patient Interactions• Evidence-based strategies for patient care• Discussions & language related to obesity• Recognition & mitigation of weight bias & stigma• Respectful accommodations for people with obesity• Special considerations for comorbid conditions

Faculty members from the School of Nursing developed a simulation that engages undergraduate public health nursing students and graduate advanced practice nursing students in assessing a patient with obesity in an ambulatory care setting. Simulation highlights the need to better integrate community and primary care to support improvement in population health outcomes.

Additional Components-view videos developed by the Rudd Center on weight bias and stigma-watch The Weight of the Nation, a four-part series developed by HBO-review the social epidemiologic, economic and population health data on obesity-conduct a community-focused impact assessment of obesity on practice

OutcomesStudents evaluated the experience positively, noting that this was one of the few times that obesity had been highlighted during their clinical education. Suggested developments include incorporation of cross-disciplinary teams and more interaction between NP and undergraduate students before/after simulation.

See also: Integrating an Obesity Simulation into Baccalaureate Nursing Education (Mangold, 2014)

UNC Chapel Hill School of Nursing

Address Social Determinants of Health

Consider patient’s home, work, and community environments

Stressors

Cultural preferences

Address interpersonal relationships and family dynamics

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Largest Connected Subcomponent in Framingham Heart Study

Christakis and Fowler. NEJM 2007;357:370

Spread of Obesity across a Social Network

32 Year Follow-up

Risk of obesity increases by:

• 57% if a friend develops obesity• 40% if a sibling develops obesity• 37% if a spouse develops obesity• Greater effect of same sex relationships

No effect on weight gain by immediate neighbors

Christakis NA and Fowler JH. NEJM 2007; 357:370

Core Principles for Clinical Providers

• Assess for obesity-related comorbidities• Employ evidence-based counseling techniques (CBT, MI

5As)• Joint decision-making• In consultation with patient, refer to an evidence-based

program or recommend an evidence-based strategy• Minimize the use of medications that may cause weight

gain• When appropriate, discuss and/or prescribe obesity

medications• When appropriate, discuss and/or refer for bariatric

surgery, and provide followup care

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Source: Rudd Center for Food Policy and Obesity

Medical Complications of Obesity

Core Principles for Clinical Providers

• Assess for obesity-related comorbidities• Employ evidence-based counseling techniques (CBT, MI,

5As)• Joint decision-making• In consultation with patient, refer to an evidence-based

program or recommend an evidence-based strategy• Minimize the use of medications that may cause weight

gain• When appropriate, discuss and/or prescribe obesity

medications• When appropriate, discuss and/or refer for bariatric

surgery, and provide follow-up care

What is the Appropriate Outcome from an Obesity Treatment/intervention?

• Community-based intervention

3-5% weight loss

• Clinical obesity intervention

5% or greater weight loss

Decrease in the co-morbidities of obesity

• Outcomes should be sustained over 6 months

• Consider activities of daily living

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Obesity Coverage in State Medicaid and

State Employee Plans

Screening / counselingScreening / counseling

Nutrition consultation

Nutrition consultation

Drug therapy

Drug therapy

Bariatric surgeryBariatric surgery

Weight management

program

Weight management

program

# o

f st

ate

s (P

Y16

/17)

State employee Medicaid

Jannah NH, et al. “Coverage for obesity prevention and treatment services: analysis of medicaid and state employee health insurance programs.” Obesity2018;26:1834-1840.

Elements Relevant to the Essential Obesity Care Benefit

Competencies Reimbursement Standard of Care

Core Obesity Care Benefit

Goals for a CoreObesity Care Benefit

• Identify evidence-based obesity treatment that can support clinically significant weight loss (≥5% reduction in body weight)

• Provide guidance on the appropriate amount, scope, duration, and delivery of obesity-related benefit offerings

• Highlight real-world examples from plans that cover obesity treatment modalities

• Support efforts to standardize the scope and availability of obesity treatment that are covered across plans/systems

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Elements of a Core Obesity Care Benefit

• Prevention and Screening

• Intensive Behavioral TherapyPhysical ActivityNutrition TherapyCBT, MI, 5 As

• Pharmacotherapy

• Bariatric Surgery

• Weight maintenance

Questions and Discussion

Please send any further comments/questions to:

[email protected]

• Look for an email containing a link to an evaluation. The email will be sent to the email address that you used to register for the webinar.

• Complete the evaluation soon after receiving it. It will expire after 3 weeks.

• You will be emailed a certificate within 2-3 business days.

• Remember: If you used your phone to call in, and want CE credit for attending, please send an email with your name to [email protected] so you receive your certificate.

TO RECEIVE YOUR CE CERTIFICATE

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Villanova.edu/cope

Upcoming FREE Continuing Education Webinar

Using genetic information to predict and treat obesity: Are we ready for precision medicine?

Ruth Loos, PhD.Charles Bronfman Professor in Personalized Medicine

Icahn School of MedicineWednesday, November 13, 2019

12-1 PM EST

QUESTIONS & ANSWERS

Moderator: Lisa K. Diewald MS, RD, LDNEmail: [email protected]: www.villanova.edu/COPE

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finding slides for today’s webinar · 2020-04-20 · 10/16/2019 5 provider knowledge of obesity...

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